Experience of Healthcare Providers on Enteral Nutrition: Challenges and Ways to Improve Current Practice
Abstract
The aim of this qualitative study is to explore the experience of Healthcare Providers (HCPs) in Enteral Nutrition (EN) practice in hospital settings, the challenges they encounter, and the possible ways to improve the current practice. The study involved conducting in-depth interviews with expert panels, including clinicians, dietitians, nurses, and academic professionals who are involved in clinical or teaching practices related to EN. The recording of the interview was transcribed verbatim after each session. The coding process was done using the computer-assisted qualitative data analysis software Atlas-Ti. The thematic analysis procedure by Braun and Clarke is used to analyze the transcription. At the end of the study, eleven interviews were conducted, transcribed, and analyzed. Six themes addressing the challenges in EN were identified. The themes are standardization of EN practice, enteral feeding provision, knowledge of nurses, attitude of HCPs, skills of nurses, and resources in the healthcare facility. In addition to that, four themes addressing the current needs of EN practice were also documented. The themes identified are EN guidelines and protocols, improving Knowledge, Attitude, and Practice (KAP) on EN, continuous education on EN, and improving healthcare facilities. The insights shared by the participants can be thoroughly examined to develop strategies for enhancing existing EN processes.
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References
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Boullata JI., Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML et al. 2017. ASPEN safe practices for enteral nutrition therapy. J Parenter Enteral Nutr 41(1):15–103. https://doi.org/10.1177/0148607116673053
Braun V, Clarke V. 2006. Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
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Cahill NE, Narasimhan S, Dhaliwal R, Heyland DK. 2010. Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: An international survey of critical care physicians and dietitians. J Parenter Enteral Nutr 34(6):685–696. https://doi.org/10.1177/0148607110361908
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Darawad MW, Alfasfos N, Zaki I, Alnajar M, Hammad S, Samarkandi OA. 2018. ICU nurses’ perceived barriers to effective enteral nutrition Practices: A multicenter survey study. Open J Nurs 12:67–75. https://doi.org/10.2174/1874434601812010067
Darawad MW, Hammad S, Al-Hussami M, Haourani E, Aboshaiqah AE, Hamdan-Mansour AM. 2015. Investigating critical care nurses’ perception regarding enteral nutrition. Nurse Educ Today 35(2):414–419. https://doi.org/10.1016/j.nedt.2014.11.023
Eu CW, Ajit Singh V, Yasin NF. 2019. Effective nutritional status screening in orthopaedic oncology patients and post-operative complications. Orthop Surg 27(2):2309499019847232. https://doi.org/10.1177/2309499019847232
Hadera T, Worku T, Tuli W. 2022. Nurses’ knowledge, practice, and associated factors with enteral nutrition in adult intensive care units of public hospitals. Ethiop J Health Sci 32(2):423–432. https://doi.org/10.4314/ejhs.v32i2.23
Hamdan M, Zidan S, Badrasawi M, Shweikeh H, Al-Masri R, Al-Khateeb R. 2022. Palestinian nurses’ knowledge, attitudes, and practices regarding enteral nutrition: Cross-sectional study. Nurs Res 63:151545. https://doi.org/10.1016/j.apnr.2021.151545
Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV, Ungpinitpong W, Usman N. 2020. Hospital malnutrition in northeast and southeast Asia: A systematic literature review. Clin Nutr ESPEN 39:30–45. https://doi.org/10.1016/j.clnesp.2020.06.001
Karim SA, Ibrahim B, Tangiisuran B, Davies JG. 2015. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. J Parenter Enteral Nutr 39(4):482–488. https://doi.org/10.1177/0148607114525209
Kim SH, Park CM, Seo JM, Choi M, Lee DS, Chang DK, Rha M, Yu S, Lee S, Kim E et al. 2017. The impact of implementation of an enteral feeding protocol on the improvement of enteral nutrition in critically ill adults. Asia Pac J Clin Nutr 26(1):27–35. https://doi.org/10.6133/apjcn.122015.01
Kozeniecki M, McAndrew N, Patel JJ. 2016. Process-related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutr Clin Pract 31(1):80–85. https://doi.org/10.1177/0884533615611845
Latiff NSMA, Ahmad N, Islahudin F. 2016. Complications associated with malnutrition in elective surgical patients in a Malaysian setting. Trop J Pharm Res 15(6):1321–1325. https://doi.org/10.4314/tjpr.v15i6.27
Lyu Y, Chen G, Shen L, Liu Y, Gao F, He X, Crilly J. 2021. Knowledge, attitudes, clinical practice and perceived barriers with nutrition support among physicians and nurses in the emergency department: A national cross-sectional survey. Int Emerg Nurs 55:100973. https://doi.org/10.1016/j.ienj.2021.100973
Martin L, De Van Der Schueren MAE, Blauwhoff-Buskermolen S, Baracos V, Gramlich L. 2016. Identifying the barriers and enablers to nutrition care in head and neck and esophageal cancers. J Parenter Enteral Nutr 40(3):355–366. https://doi.org/10.1177/0148607114552847
McClave SA, Dibaise JK, Mullin GE, Martindale RG. 2016. ACG clinical guideline: Nutrition therapy in the adult hospitalized patient. Am J Gastroenterol Suppl 111(3):315–334. https://doi.org/10.1038/ajg.2016.28
Melariri HI, Kalinda C, Chimbari MJ. 2021. Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective. Plos One 16(11): e0259884. https://doi.org/10.1371/journal.pone.0259884
Mirhosiny M, Arab M, Shahrbabaki PM. 2021. How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit? Acute Crit Care 36(4):342–350. https://doi.org/10.4266/acc.2021.00185
Mooi NM, Ncama BP. 2020. Enteral nutritional therapy practices for adults in a district hospital and primary healthcare centers in KwaZulu-Natal province of South Africa: Knowledge and attitude of health care professionals. International Journal of Africa Nursing Sciences 12:100202. https://doi.org/10.1016/j.ijans.2020.100202
Morphet J, Clarke AB, Bloomer MJ. 2016. Intensive care nurses’ knowledge of enteral nutrition: A descriptive questionnaire. Intensive Crit Care Nurs 37:68–74. https://doi.org/10.1016/j.iccn.2016.07.001
O’Leary-Kelley C, Bawel-Brinkley K. 2017. Nutrition support protocols: Enhancing delivery of enteral nutrition. Crit Care Nurse 37(2):e15–e23. https://doi.org/10.4037/ccn2017650
Seferoğlu N, Özyürek P, Gürlek Kisacik Ö. 2021. Enteral nutrition management in the critical care patient: Intensive care nurses' practices of tube feeding. Progr Nutr 23(S2):e2021236. https://doi.org/10.23751/pn.v23iS2.11902
Padar M, Uusvel G, Starkopf L, Starkopf J, Reintam Blaser A. 2017. Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study. World J Crit Care Med 6(1):56. https://doi.org/10.5492/wjccm.v6.i1.56
Persenius MW, Larsson BW, Hall-Lord ML. 2006. Enteral nutrition in intensive care: Nurses’ perceptions and bedside observations. Intensive Crit Care Nurs 22(2):82–94. https://doi.org/10.1016/j.iccn.2005.09.001
Queno, JP, Plantefeve G, Baudel JL, Camilatto I, Bertholet E, Cailliod R, Reignier J, Rigaud JP. 2010. Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: A prospective, multi-centre, observational study. Crit Care 14(2):1–7. https://doi.org/10.1186/cc8915
Ramuada L, Veldsman L, Livhuwani N, Blaauw R. 2023. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. South Afr J Clin Nutr. 36(2):63–69. https://doi.org/10.1080/16070658.2022.2076970
Rekisso AD, Mengistu Z, Wurjine TH. 2022. Nurses’ attitudes towards the nursing profession and associated factors in selected public hospitals, Addis Ababa, Ethiopia, 2021: A cross-sectional study. BMC Nurs 21(1):21. https://doi.org/10.1186/s12912-022-00808-2
Schaefer A, Benbenishty J, Gutysz-Wojnicka A, Slijepcevic J, Scelsi S, Bruyneel A, Klas MK. 2019. Nurses responsibilities on providing enteral nutrition to the critically ill patient—An European federation of critical care nursing associations position paper. Connect: The World of Critical Care Nursing 12(3):86–89. https://doi.org/10.1891/1748-6254.12.3.86
Tong A, Sainsbury P, Craig J. 2007. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J Qual Health Care 19(6):349–357. https://doi.org/10.1093/intqhc/mzm042
Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Holcombe B Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society for Parenteral and Enteral Nutrition . 2018. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 33(6):906–920. https://doi.org/10.1002/ncp.10204
Alsoqeah F, Alyumni R, Alruwaili N, Aldubayan K. 2023. A qualitative study investigating the current practices, obstacles, and needs of enteral nutrition support among registered dietitians managing non-critically ill hospitalized patients in Riyadh, Saudi Arabia. Saudi J Health Syst Res 3(1):10–22. https://doi.org/10.1159/000528652
Boland K, Allen K, James A, Dunne C. 2022. Starving for knowledge. Addressing the place of clinical nutrition within undergraduate and postgraduate clinical training: A national survey of practicing clinicians. Clin Nutr ESPEN 52:377–380. https://doi.org/10.1016/j.clnesp.2022.09.020
Boullata JI., Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML et al. 2017. ASPEN safe practices for enteral nutrition therapy. J Parenter Enteral Nutr 41(1):15–103. https://doi.org/10.1177/0148607116673053
Braun V, Clarke V. 2006. Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
Cahill NE, Murch L, Cook D, Heyland DK, Canadian Critical Care Trials Group. 2012. Barriers to feeding critically ill patients: A multicenter survey of critical care nurses. J Crit Care 27(6):727–734. https://doi.org/10.1016/j.jcrc.2012.07.006
Cahill NE, Narasimhan S, Dhaliwal R, Heyland DK. 2010. Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: An international survey of critical care physicians and dietitians. J Parenter Enteral Nutr 34(6):685–696. https://doi.org/10.1177/0148607110361908
Cederholm T, Barazzoni ROCCO, Austin P, Ballmer P, Biolo GIANNI, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M et al. 2017. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 36(1):49–64. https://doi.org/10.1016/j.clnu.2016.09.004
Darawad MW, Alfasfos N, Zaki I, Alnajar M, Hammad S, Samarkandi OA. 2018. ICU nurses’ perceived barriers to effective enteral nutrition Practices: A multicenter survey study. Open J Nurs 12:67–75. https://doi.org/10.2174/1874434601812010067
Darawad MW, Hammad S, Al-Hussami M, Haourani E, Aboshaiqah AE, Hamdan-Mansour AM. 2015. Investigating critical care nurses’ perception regarding enteral nutrition. Nurse Educ Today 35(2):414–419. https://doi.org/10.1016/j.nedt.2014.11.023
Eu CW, Ajit Singh V, Yasin NF. 2019. Effective nutritional status screening in orthopaedic oncology patients and post-operative complications. Orthop Surg 27(2):2309499019847232. https://doi.org/10.1177/2309499019847232
Hadera T, Worku T, Tuli W. 2022. Nurses’ knowledge, practice, and associated factors with enteral nutrition in adult intensive care units of public hospitals. Ethiop J Health Sci 32(2):423–432. https://doi.org/10.4314/ejhs.v32i2.23
Hamdan M, Zidan S, Badrasawi M, Shweikeh H, Al-Masri R, Al-Khateeb R. 2022. Palestinian nurses’ knowledge, attitudes, and practices regarding enteral nutrition: Cross-sectional study. Nurs Res 63:151545. https://doi.org/10.1016/j.apnr.2021.151545
Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV, Ungpinitpong W, Usman N. 2020. Hospital malnutrition in northeast and southeast Asia: A systematic literature review. Clin Nutr ESPEN 39:30–45. https://doi.org/10.1016/j.clnesp.2020.06.001
Karim SA, Ibrahim B, Tangiisuran B, Davies JG. 2015. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. J Parenter Enteral Nutr 39(4):482–488. https://doi.org/10.1177/0148607114525209
Kim SH, Park CM, Seo JM, Choi M, Lee DS, Chang DK, Rha M, Yu S, Lee S, Kim E et al. 2017. The impact of implementation of an enteral feeding protocol on the improvement of enteral nutrition in critically ill adults. Asia Pac J Clin Nutr 26(1):27–35. https://doi.org/10.6133/apjcn.122015.01
Kozeniecki M, McAndrew N, Patel JJ. 2016. Process-related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutr Clin Pract 31(1):80–85. https://doi.org/10.1177/0884533615611845
Latiff NSMA, Ahmad N, Islahudin F. 2016. Complications associated with malnutrition in elective surgical patients in a Malaysian setting. Trop J Pharm Res 15(6):1321–1325. https://doi.org/10.4314/tjpr.v15i6.27
Lyu Y, Chen G, Shen L, Liu Y, Gao F, He X, Crilly J. 2021. Knowledge, attitudes, clinical practice and perceived barriers with nutrition support among physicians and nurses in the emergency department: A national cross-sectional survey. Int Emerg Nurs 55:100973. https://doi.org/10.1016/j.ienj.2021.100973
Martin L, De Van Der Schueren MAE, Blauwhoff-Buskermolen S, Baracos V, Gramlich L. 2016. Identifying the barriers and enablers to nutrition care in head and neck and esophageal cancers. J Parenter Enteral Nutr 40(3):355–366. https://doi.org/10.1177/0148607114552847
McClave SA, Dibaise JK, Mullin GE, Martindale RG. 2016. ACG clinical guideline: Nutrition therapy in the adult hospitalized patient. Am J Gastroenterol Suppl 111(3):315–334. https://doi.org/10.1038/ajg.2016.28
Melariri HI, Kalinda C, Chimbari MJ. 2021. Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective. Plos One 16(11): e0259884. https://doi.org/10.1371/journal.pone.0259884
Mirhosiny M, Arab M, Shahrbabaki PM. 2021. How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit? Acute Crit Care 36(4):342–350. https://doi.org/10.4266/acc.2021.00185
Mooi NM, Ncama BP. 2020. Enteral nutritional therapy practices for adults in a district hospital and primary healthcare centers in KwaZulu-Natal province of South Africa: Knowledge and attitude of health care professionals. International Journal of Africa Nursing Sciences 12:100202. https://doi.org/10.1016/j.ijans.2020.100202
Morphet J, Clarke AB, Bloomer MJ. 2016. Intensive care nurses’ knowledge of enteral nutrition: A descriptive questionnaire. Intensive Crit Care Nurs 37:68–74. https://doi.org/10.1016/j.iccn.2016.07.001
O’Leary-Kelley C, Bawel-Brinkley K. 2017. Nutrition support protocols: Enhancing delivery of enteral nutrition. Crit Care Nurse 37(2):e15–e23. https://doi.org/10.4037/ccn2017650
Seferoğlu N, Özyürek P, Gürlek Kisacik Ö. 2021. Enteral nutrition management in the critical care patient: Intensive care nurses' practices of tube feeding. Progr Nutr 23(S2):e2021236. https://doi.org/10.23751/pn.v23iS2.11902
Padar M, Uusvel G, Starkopf L, Starkopf J, Reintam Blaser A. 2017. Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study. World J Crit Care Med 6(1):56. https://doi.org/10.5492/wjccm.v6.i1.56
Persenius MW, Larsson BW, Hall-Lord ML. 2006. Enteral nutrition in intensive care: Nurses’ perceptions and bedside observations. Intensive Crit Care Nurs 22(2):82–94. https://doi.org/10.1016/j.iccn.2005.09.001
Queno, JP, Plantefeve G, Baudel JL, Camilatto I, Bertholet E, Cailliod R, Reignier J, Rigaud JP. 2010. Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: A prospective, multi-centre, observational study. Crit Care 14(2):1–7. https://doi.org/10.1186/cc8915
Ramuada L, Veldsman L, Livhuwani N, Blaauw R. 2023. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. South Afr J Clin Nutr. 36(2):63–69. https://doi.org/10.1080/16070658.2022.2076970
Rekisso AD, Mengistu Z, Wurjine TH. 2022. Nurses’ attitudes towards the nursing profession and associated factors in selected public hospitals, Addis Ababa, Ethiopia, 2021: A cross-sectional study. BMC Nurs 21(1):21. https://doi.org/10.1186/s12912-022-00808-2
Schaefer A, Benbenishty J, Gutysz-Wojnicka A, Slijepcevic J, Scelsi S, Bruyneel A, Klas MK. 2019. Nurses responsibilities on providing enteral nutrition to the critically ill patient—An European federation of critical care nursing associations position paper. Connect: The World of Critical Care Nursing 12(3):86–89. https://doi.org/10.1891/1748-6254.12.3.86
Tong A, Sainsbury P, Craig J. 2007. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J Qual Health Care 19(6):349–357. https://doi.org/10.1093/intqhc/mzm042
Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Holcombe B Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society for Parenteral and Enteral Nutrition . 2018. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 33(6):906–920. https://doi.org/10.1002/ncp.10204
Authors
Abd Kadir, N. S., Zaman, M. K., Ahmad Sharoni, S. K., & Mohd Fahmi Teng, N. I. (2025). Experience of Healthcare Providers on Enteral Nutrition: Challenges and Ways to Improve Current Practice. Jurnal Gizi Dan Pangan, 20(Supp.1), 19-28. https://doi.org/10.25182/jgp.2025.20.Supp.1.19-28
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Abd Kadir, N. S., Zaman, M. K., Ahmad Sharoni, S. K., & Mohd Fahmi Teng, N. I. (2025). Experience of Healthcare Providers on Enteral Nutrition: Challenges and Ways to Improve Current Practice. Jurnal Gizi Dan Pangan, 20(Supp.1), 19-28. https://doi.org/10.25182/jgp.2025.20.Supp.1.19-28
